A systematic review 1 including 14 studies with a total of 10 973 subjects or blood samples was abstracted in DARE. The studies were mostly from sub-Saharan Africa with heterogeneous populations, health care settings, anaemia prevalence, and findings. The included studies used HemoCue, automated analyser, photometer and copper sulphate methods as the reference standard. Six studies were laboratory based with adequate training, four were real-life with short training, and the remaining four had elements of both (e.g. laboratory based with inadequate training or real-life with extensive training). Haemoglobin colour scale (HCS) sensitivity for detecting anaemia was high in most of the studies (75-97%); specificity was generally lower (41-98%). Sensitivity and specificity were higher for laboratory-based studies compared with more pragmatic 'real-life' studies, and the 'study setting' appeared to explain some of the heterogeneity. Five studies compared the HCS with clinical diagnosis; sensitivity was higher for the HCS in four studies, but specificity was often higher with clinical diagnosis.
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